OBJECTIVE

To study functional state of endothelium, its relationship with severity of COVID-19 and dynamics under therapy with Mexidol.

MATERIAL AND METHODS

Sixty-two patients with COVID-19 (according to CT of the lungs (CT1-3) or PCR for viral RNA) over 18 years old (NEWS2 score 1-6) underwent routine examination after 1 and 8 days. Endothelial function parameters were assessed using occlusive test (AngioScan Electronics LLC). Patients were randomized into infusion of Mexidol 1000 mg/day and saline solution for 7 days.

RESULTS

All patients in acute phase of COVID-19 had low phase shift values that indicated endothelial dysfunction at the level of large muscular arteries. Two thirds of patients had decrease of occlusion index that was interpreted as a part of endothelial dysfunction at the level of microcirculation. Patients were divided into subgroups with and without endothelial dysfunction at the level of microcirculation. Under therapy with mexidol, phase shift change (Δ) increased by 7 ms in subgroup with endothelial dysfunction and by 3 ms in subgroup without dysfunction. In the control group, this indicator either decreased by 3 ms or did not change, respectively. At the 1st visit, phase shift correlated with C-reactive protein (r= –0.386; p=0.004) and D-dimer (r= –0.326; p=0.035). No correlations were established for occlusion index. At the 2nd visit, higher correlation between phase shift and D-dimer was observed (r= –0.477; p=0.025).

CONCLUSION

Patients with COVID-19 have endothelial dysfunction at the level of large muscular arteries and microvasculature. The relationship of inflammation with phase shift suggests that improving endothelial function may be a target in the treatment of a new coronavirus infection. Mexidol as antioxidant improving phase shift can be considered as additional line of therapy in patients with COVID-19.